Provider Demographics
NPI:1750606554
Name:GOODSPEED, LAWRENCE R
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:GOODSPEED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1846
Mailing Address - Country:US
Mailing Address - Phone:518-747-4732
Mailing Address - Fax:518-747-6667
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1846
Practice Address - Country:US
Practice Address - Phone:518-747-4732
Practice Address - Fax:518-747-6667
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist